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health tips

School Bags a source of Spinal Strain?

I've been invited to speak at the upcoming Smart Kids Asia Expo

While backpacks are one of the most convenient and frequently used ways to carry books and school supplies, there are numerous precautions for selection and use. Doctors of Chiropractic have been offering constructive suggestions about this issue for many years.
Wearing backpacks improperly or carrying ones that are too heavy put children at increased risk for spinal injury. Postural compensations carrying the heavy loads are causing what chiropractors term repetitive stress injury to many children. The postural imbalances appear to be most significant with prepubescent female students because of the heavy load required to carry at their ages and the sensitivity of their developing spines at this time of life.
We know that back pain is the most common ailment among working Americans adults. Even more significant than back pain and associated injury is the implications that postural distortions have on nerve system function. These postural adaptations can cause spinal nerve stress. Stress to the nervous system can adversely affect numerous functions in the body leading to a wide array of health concerns.

Doctors of Chiropractic offer these tips for safe backpack use:
  • Wear both straps and avoid the one-strap styled back packs. Uneven distribution of the load causes postural compensations and spinal stress.
  • When putting on and removing backpacks, bend at the knees or have the pack at a higher level such as on a desk or table. Sudden twisting motion adds to the potential of injury.
  • Arrange the backpack so it rests evenly in the middle of the back. Shoulder straps should be adjusted to allow the child to put on and take off the backpack without difficulty and permit free movement of the arms. Straps should not be too loose, and the backpack should not extend below the lower back.
  • Keep the load at 10-15% or less of the student’s bodyweight. Carry only those items that are required for the day. Request additional textbooks to be kept at home instead of hauling heavy books to and from school.
  • Organize the contents of the backpack by placing the heaviest items closest to the back.

There are some ergonomically designed features in backpacks that enhance safety and comfort:
  • A padded back and shoulder straps will reduce pressure on the back, shoulders, and underarm regions, and enhance comfort.
  • Hip and chest belts help to transfer some of the backpack weight from the back and shoulders to the hips and torso.
  • Reflective material enhances visibility of the child to drivers in the evening hours.

Does cracking your back or knuckles cause arthritis? Is it bad?

Does cracking your back or knuckles cause arthritis? Is it bad?

Is it bad to crack your own neck, back or knuckles? Does it cause arthritis? What about thai massages, the barber or my friend who steps on my back? How's that any different to a chiropractor who 'cracks' my back? All the answers are here! 

3 silly reasons why frozen shoulder doesn’t heal

3 silly reasons why frozen shoulder doesn’t heal

3 silly reasons why frozen shoulder doesn’t heal - And since they are simple, you'll kick yourself. They are also easy to avoid too! It's time to get our shoulders (and quality of life) back!

(This applies to other shoulder injuries too! Say good bye to shoulder pain, rotator cuff injury, shoulder impingement syndrome and tendonitis!)

Pain-Free Travel is Easy!

Pain-Free Travel is Easy!

Flying to your favourite destinations this festive season? Although you may be making you friends envious, your body is probably thinking “No!! Not another long flight, cramped leg space, dry skin, bland food and changes in time zones!”


You may have worked your game plan - a neck pillow, ear plugs, and an eye mask. And yet those stiff shoulders and neck or back pain still haunt you. Prolonged sitting and poor posture can cause plenty of discomfort, especially when you add on the pressure, humidity and cramped conditions of an air plain. If these poor posture habits are not changed, the discomforts will soon turn into pain, ruining your holiday plans. So what can you do to prevent the unnecessary suffering? Keep our handy ABC’s with you on your coming trip!

Stress: The Brain-Body Connection

Stress: The Brain-Body Connection

We know the human body adapts to survive on a daily basis. We see this when we encounter a virus and the body adapts to shut it down. It also occurs when we have a fever and the body adapts to take care of it, thus returning the system to homeostasis. When the body is unable to adapt to both the internal and environmental conditions that affect it, it becomes easy for illness to develop and thrive. This is one reason chiropractors take a keen interest in supporting the neurological and physiological systems within the body – so that there are minimal impediments to adaptation, thus allowing the body to thrive and heal.


Sit too long? Yes. Regardless if we exercise or not, we sit longer than any other generation. Even with our wonderful wearable tech gadgets and our gym sessions, our daily sitting habits increase our risk of heart disease, diabetes, cancer and death. Simply put, regular workouts, with all its health benefits, do not entirely counteract the negative effects of sitting.



Studies show that many children carry backpacks heavily loaded with more than the recommended maximum weight. This is well known among Singaporean Parents, as their children are required to bring school books to and from school and tuition. A recent study has shown that children are also likely to experience neck and shoulder pain, as well as the commonly-reported back pain. 

However, pain does not always show up immediately. Many children develop other signs and symptoms before pain sets in. In practice, I hear complaints of poor posture, difficulty finding a comfortable sitting or sleeping position, difficulty concentrating, stiffness, headaches, and general non-specific unease or discomfort. 


So I would like to issue a warning to parents this January – check the weight and fitting of your child’s bag before they go back to school to avoid the risk of long term spinal damage.

Children should not carry loads of more than 10 per cent of their own body weight to maintain normal postural alignment and the backpack should be no wider than their chest. Lifting a bag that is too heavy causes immediate strain on the spine and the longer a child carries the load, the more severe the damage. 

I strongly suggest that students make use of school lockers, observe timetables and plan homework well in advance to reduce the need to carry large numbers of books in the one journey.  

The ideal backpack should have broad, adjustable shoulder straps that distribute weight evenly across the shoulders. They should also feature waist straps (like you can find on trekking packs) that distribute weight evenly across the hips and hold the backpack firmly to the spine. 

Having these features are fantastic, though I would urge parents to remind their children that how they use the backpack and features is more important. To gain maximum benefit from these features, your children must use both straps, and keep the straps tight enough that the backpack stays on the back and above the hips. 

When packing your school bag, all heavy items, including text books, tablets or laptops, should be packed at the bottom of the backpack and as close to the spine as possible.

There are numerous backpacks that Dr Gary Tho recommends including the Ergobag, Satch, McNeil and the MoonRock Bag, the latest lightweight ergonomic school bag for kids. Connect with him on email, Facebook, Twitter, or LinkedIn for recommendations and any current promotions on kids ergonomic bags, bedding and chairs, desks and the like. 





  1. Backpacks should be no heavier than 10 per cent of the child’s body weight when packed
  2. Make sure the backpack is sturdy and appropriately sized - no wider than the child’s chest
  3. Put the backpack’s comfort and fit at the top of the priority list rather than good looks
  4. Choose a pack with broad, padded shoulder straps
  5. Use both shoulder straps – never sling the pack over one shoulder
  6. Use the waist straps attached – they’re there for a very good reason!
  7. Don’t wear the backpack any lower than the hollow of the lower back
  8. Don’t overload the backpack – use school lockers & plan homework well in advance
  9. Place all heavy items at the base of the pack and close to the spine
  10. Invite Dr Gary Tho to speak at your school for further helpful tips, hands-on assessments and solutions 


Dr Gary Tho is the owner of Chiropractic Works, a Family Sports and Wellness clinic in Orchard Road, Singapore. He specialises in pain relief and preventative care and believes quality life is essential for happiness, success and peak performance. For more information and advice, phone Dr Gary Tho on +65 6733 4439.